BMCH2016-042878-495 CALkE TAM PfCO D 4 Q91AZ
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O16-0428
Property Address: 57667 1NTERLACHEN
APN: 762230003
Application Description: FOLLI / CHANGE OUT (2) SPLIT SYSTEM
Property Zoning:
Application Valuation: $17,600.00
Applicant:
TIMO'S AIR CONDITIONING & HEATING INC.
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
(760)770-4357
Llc. No.: 920062
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C20 icense No.: 920062
Wer which this permit is issued.
e and will maintain workers' compensation insurance, as required by
Contractor Sthe Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
OWNER -BUILDER DECLARATION Carrier: NORGUARD INSURANCE COMPANY Policy Number: TIWC721117
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a workers'. compensation provisions of. Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the comply with th7se provi 'ons.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division , /J
3 of the Business and Professions Code) or that he or she is exempt therefrom and the Date: Applican /��(�
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a `
permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILU E TO SECURE WORKE%PENSATION COCRE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
I ) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES.
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements APPLICANTACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose
(-__) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of la Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason 2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
Date:
Owner:
' CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above -menti ed pr perty for inspection purposes.
Date:7if Signature (Applicant or Age
Date:
11/29/2016
Owner:
HUGO FOLLI
576671NTERLACHEN
o
LA QUINTA, CA 92253
CDz
o
Contractor:
Cg
TIMO'S AIR CONDITIONING & H TIGt
INS C�
72232 CORPORATE WAY
Z+ 1
a
THOUSAND PALMS, CA 92276
x I
(760)770-4357
Llc. No.: 920062
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: C20 icense No.: 920062
Wer which this permit is issued.
e and will maintain workers' compensation insurance, as required by
Contractor Sthe Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
OWNER -BUILDER DECLARATION Carrier: NORGUARD INSURANCE COMPANY Policy Number: TIWC721117
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a workers'. compensation provisions of. Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the comply with th7se provi 'ons.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division , /J
3 of the Business and Professions Code) or that he or she is exempt therefrom and the Date: Applican /��(�
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a `
permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILU E TO SECURE WORKE%PENSATION COCRE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
I ) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES.
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements APPLICANTACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose
(-__) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of la Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason 2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
Date:
Owner:
' CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above -menti ed pr perty for inspection purposes.
Date:7if Signature (Applicant or Age
Date: 11/29/2016
Application -Number: i BMCH2016-0428
Owner:
Property Address' 576671NTERLACHEN
HUGOFOLLI
APN: 762230003
576671NTERLACHEN
Application Description: FOLLI / CHANGE OUT (2) SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $17,600.00
Applicant:
Contractor:
TIMO'S AIR CONDITIONING & HEATING INC
TIMO'S AIR CONDITIONING & HEATING INC
72232 CORPORATE WAY
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)770-4357
---------------------------------------------------------------------------------------------
Llc. No.: 920062
Detail: HVAC CHANGE OUT- (2)16SEER/80AFUE SPLIT SYSTEMS [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
I -
ti
DESCRIPTION
FINANCIALINFORMATIOW
ACCOUNT QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid far BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT-SYSTEM
101-0000-42402
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$76.00
Total Paid for CHANGEOUT:
$228.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE:
$96.27
I, IUTALJ: :�325.Z7
APPUCANT: DO NOT WRITE BELOW THIS LINE
City of La -Quinta
gill#
-Building U Safety Division
#I
P.O. Box 1504, 78,495 Calle Tampico .
Permit #La
Quints, CA 92253 - (760) 777-7012
iitACKII�IG
Building. Permit Application and Tracking - Sheet
Plan Sets
�i¢ e (� Owner -s Name: 0 D L / ' 1
project Address: �p lo -7
A. P. Number.
Address: s7�p�yt)T� 1�"'
Legal DcSuiption:
City, ST, Zip CP teJ7 e.73
Contractor: �d6l J
Telephone: - �
Pro ed Description:
Address:
City, ST, Zip:
a
Telephone:
10 0
State Lic. # : QO
City Lie. C
Arch., Engr., Designer:
Address:
Title 24 Cates,
City, ST, Zip:
Telephone:
,. Occupancy:
ConstYu4tion Type:
State Lie. #:
project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: _" ip
—77 Sq. FL: # Stories:
# Units:
..
'Telephone #,of Contact Prison:
`
Q -C,/ Estimated Value of Proj 171
APPUCANT: DO NOT WRITE BELOW THIS LINE
PERMIT FEES
#I
Submittal
Reg'd
Rcc'd
iitACKII�IG
Plan Sets
Ma Check submitted Item Amount
Reviewed, ready for corrections Plan Check Deposit
Structural Cales.
Plan Cheek Balance
Truss Cale;.
Called Contac; Person
Construction
Title 24 Cates,
Plans picked up
p
Plans resubmitted Mechanical
V Review, ready for correctionsr'issue Eteetrical
Plumbing
Called Contact Person
Plans picked up S'M I.
Plans resubmitted Grading
.
''d Reyiew, ready for corrcctlonsfissue Developer Impact Fee _.
Flood plain plan
Grading plan
Subcontactor Llst
Grant Decd
Ii.O.A. Approval
IN a�ovsE:-
Planning Approval
Called Contact Person A.Mpa
Date of permit Issue
. Total Permit Tees '
Pub. Wks. Appr
$drool Res
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: Hugo Folli Date Prepared: 2016-11-28
A. General Information +
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CF1R-ALT-02 document for each dwelling unit.
01
Project Name
Hugo Folli
02
Date Prepared
2016-11-28
03
Project Location
57667 Interlachen
04
Building Type
Single family
OS
CA City
La Ctuinta
06
Dwelling Unit Name
Hugo Folli
07
Zip Code
92253
08
Dwelling Unit Conditioned
2870
nstallin"g
--Installing
Installing
Floor Area (ft2)
Location or Area
b this SC
Y
ducted
c Mainin g
s ystem
Number of space conditioning
rit4r
entirely new
09
Climate Zone
15
30
(SC) systems in this dwelling
2 — --- —
component?
components?
feet of ducts?
ductsystem?
unit.
Alteration Type
+ �$})
B. Space Conditioning (SC) System Information A7 00k s'C 9#i
OS
02
.03*' n
• •.
044,O
14O #
06�
07 � _
08
� 09
30
'+�
Is the SC
D :it "+eLybj.w3t
Installing a
ai '.i.'fOi+�
6i iW MP
y�i W
SC System
SC System
CFA served
's a
refrigerant
.Installing new SC
' ' ' x
nstallin"g
--Installing
Installing
Identification or
Location or Area
b this SC
Y
ducted
c Mainin g
s ystem
more than 40
rit4r
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
ductsystem?
SC system?
Alteration Type
System 1
Common Area
1700
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
Bedroom area
1170
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1D1ib)
This section does not apply to this project.
Registration Number: 216-AO437667A-000000000-0000 Registration Date/Time: 2016-11-28 09:37:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-28 09:38:05
- Schema Version: O.SSSSDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
s
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
M
D. Altered Space Conditioning System (Sections 150.2(b)IE and F)
01
02
03
04
05
06
07
08
09
30
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
All new
split
All new
This field or
This field or
System 1
furnace
heatingCentral
'
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section isnot
components
components
applicable
I applicable
Central gas
All new
Central split
All new
This field or
This field or
System 2
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans a�
-Duct insulation requirement for new plenums: R6.,, .L
CF2R-MCH-20-H & CF311-MCH-20-1-1 — Duct Leakage testing required when heating orcoolirlg components are installed
in ducted
systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: 515%, or 5 10% leakage to outside, or seal allaccessible leaks. 9n+'++�4 sever
ging
CF2R-MCH-ZS-H & CF3R-MCH-25-H Refrigerant Charge Verifiption required when r"reefrigerant conta components
are iintalled
or"ahered (appkwble m Q2; 8-15).mc.
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air. Flow 2:300 CFM/ton requimd when MCH•25 is regui Ay
-Duct systems registered with HERS provider as previously sealed are.ezempt from MCFh20.DuccLeakage Teasti;rg req�uvements.
verification
-Heating-only systems and Air Handler/Furnace changes do not r'uepuitre of Air Flow MCH -23 or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos '=exempt exempt fromMCHk20 DuRLeakage westing regwremeM�s: -
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)IDiia and 150.2(b)IE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 216-A0437667A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-11-28 09:37:57 HERS Provider: CaICERTS
Report Version: 2013 Rev 1.008 Report Generated: 2016-11-28 09:38:05
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Timo Joseph
Documentation Author Signature: ry�p/�_�j,
d_ 92/?w
,
_ 7 _
Company:
Signature Date:
TIMO'S AIR CONDITIONING & HEATING INC
2016-11-28 09:37:57
Address:
CEA/ HERS Certification Identification (if applicable):
72232 Corporate Way
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-770-4357
Responsible Person's Declaration statement -
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept: responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, components, and devices for the building design or system design identified on this Certificate of Compliance conform to the
tmanufactured
requirements of Title 24, Part 1 and Part 6 o the Caldnmia`Code of Regulations �' /, 1
Vns1sistent.wrth-the
4. The building design features or system design features identified on''this Certificate Cbmpliance are inform aittion.m ovided ontjother a plicable compliance documents, worksheets,
��
,dew ,a ':s� fr
calculations, plans and specifications submitted io the enforcement agency for approval.with this building perrnn appliication.
shall available with
S. I will ensure that a registered copy of this Certificatef��mpliance be;made the building permit(s):asued for the building, andU air a b tathe enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliancevl!�,required to be included with theme umentation*he�builder prrovidddessQtto the building owner at occupancy.
Responsible Designer Name: is 1Z 1 •t ..i
Timo Joseph
Responiible Designer Signature: V III (� ti•• 'Z��'--%
,
r
Company:
Date Signed:
TIMO'S AIR CONDITIONING & HEATING INC
2016-11-28 09:37:57
Address:
License:
72232 Corporate Way
920062
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-770-4357
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered documerK and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 216-A0437667A-000000000-0000 Registration Date/Time: 2016.11-28 09:37:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance ReportVersion: 2013 Rev 1.008 Report Generated: 2016-11-28 09:38:05